Monday Pharmaceutical Mystery: June 8

Why is a patient prescribed an eye drop to be instilled in her mouth?

It is a busy day at the pharmacy. It is only noon, and your team has already processed 500 prescriptions. The technician approaches you with a prescription and asks, “Should I call the doctor about these directions?”

He hands you the written prescription and it reads: atropine 1% eye drops, 1-2 drops orally q1 hours round the clock.

You look in the computer for more information. The customer is a female, age 79 years, who also has an active prescription for morphine concentrated liquid and lorazepam concentrated liquid.

Mystery: Why is this patient prescribed an eye drop to be instilled in her mouth?

Solution: Atropine is an anticholinergic drug that dries up secretions. It is being used the manage the excessive respiratory secretions associated with end of life care. The high dose morphine and lorazepam are also palliative medications.

REFERENCE

Protus BM, Grauer PA, Kimbrel JM. Evaluation of atropine 1% ophthalmic solution administered sublingually for the management of terminal respiratory secretions. Am J Hosp Palliat Care. 2013;30(4):388‐392. doi:10.1177/1049909112453641